BACKGROUND AND OBJECTIVES: As mitral stenosis worsens, the cardiac output can be reduced, with a compensatory increase in the sympathetic nervous activity. An accelerated sympathetic nervous activity is responsible for various pathophysiological changes, including atrial thrombus formation, pulmonary congestion and myocardial ischemia. In this study, the sympathetic nervous activity was evaluated in patients with rheumatic mitral valvular stenosis, both before and after a percutaneous mitral balloon valvuloplasty (PMV). SUBJECTS AND METHODS: A PMV was successfully performed in 19 patients with mitral stenosis. The hemodynamic data were obtained by Swan-Ganz catheterization, and the variability in the heart rate evaluated by time domain measure via 24-hour ECG monitoring. An exercise test was performed according to Chung's exercise protocol, with the plasma norepinephrine level obtained before, during and after exercise. RESULTS: After the PMV, the right ventricle systolic, mean pulmonary arterial, pulmonary capillary wedge and left atrial pressures were significantly decreased. However, there were no significant changes in the right atrial, right ventricle end-diastolic and left ventricle end-diastolic pressures. After the PMV, the plasma norepinephrine level, an indicator of the sympathetic activity, was significantly decreased. On the other hand, the variability in heart rate, indicator of parasympathetic activity, was significantly decreased. CONCLUSION: In patients with mitral valvular stenosis, the sympathetic activity is accelerated, while the parasympathetic activity is decreased. This situation can be immediately reversed after a successful PMV.
Atrial Pressure ; Balloon Valvuloplasty* ; Capillaries ; Cardiac Output ; Catheterization, Swan-Ganz ; Constriction, Pathologic ; Electrocardiography ; Estrogens, Conjugated (USP) ; Exercise Test ; Hand ; Heart Rate ; Heart Ventricles ; Hemodynamics ; Humans ; Mitral Valve Stenosis* ; Myocardial Ischemia ; Norepinephrine ; Plasma ; Sympathetic Nervous System ; Thrombosis

A 58-year-old male patient with situs inversus totalis, a rare congenital malformation characterized by all asymmetric organs being formed as the mirror images of their normal morphologies, underwent mitral valve repair due to mitral valve prolapse. This case was reported to suggest that anesthesiologists should thoroughly understand the anatomy of these types of patients before providing cardiac anesthesia that often requires advanced monitoring and rely on their accurate interpretation. Accordingly, a few key points will be discussed with emphasis on reversing lead placement during electrocardiogram monitoring, using the left internal jugular vein for pulmonary artery catheterization, and firmly comprehending mirror image heart morphology to better conduct transesophageal echocardiography.
Anesthesia ; Catheterization, Swan-Ganz ; Echocardiography, Transesophageal ; Electrocardiography ; Heart ; Humans ; Jugular Veins ; Male ; Middle Aged ; Mitral Valve ; Mitral Valve Prolapse ; Situs Inversus ; Thoracic Surgery

No abstract available.
Angiocardiography*

The principle of ambulatory cardiac output (CO) measuring technique is introduced in this paper. Experimental studies about the applicability of the two-compartment coaxial cylindrical model for ambulatory measurement of cardiac output with spot-electrodes have been carried out with using our newly-developed multi-channel impedance mapping system. The key factors using a spot-electrode array instead of a conventional band-electrode array for non-invasive CO) measurement are elaborated. The variations of the electric impedance pulsatile component (deltaZ waveform) and the two kinds of typical modes of deltaZ distributions measured by six electrodes on the midsternal (midian) line from the medial portion at the level of clavicle to the portion above the xiphisternum are discussed. The applicability of the two-compartment coaxial cylindrical model for ambulatory measurement of CO with spot-electrodes is analyzed. Synthesizing the deltaZ distributions and their typical changing models on the midsternal (midian) line during blood inflowing into aorta is the optimal positions of a pair of spot-electrodes for voltage pick-up at the level of clavicle for the upper electrode and the position at the level of nipple for the lower electrode when spot-electrode is being used to measure non-invasive CO.
Biomedical Engineering ; Cardiac Output ; physiology ; Cardiography, Impedance ; instrumentation ; methods ; Electrocardiography, Ambulatory ; instrumentation ; methods ; Electrodes ; Equipment Design ; Heart ; physiology ; Humans ; Models, Cardiovascular ; Thorax

This report is based on analysis of admissions to the department of pediatric at the Wonju Christian Hospital during the 3 3/4-year period from January 1989 to September 1993 with an Isolated ostium secundum ASD. Several methods of assessment of ASD size, namely, echographic, pulmonary-to-systemic flow ratio(Qp:Qs), and angiographic measures, were undertaken in a group of 37 patients, who were being evaluated for transcatheter closure of ASD; the results were compared with the operation diameter. The result of study was as follows : 1) The (Qp:Qs) ratio have no significant(p>0.01) correlation with the operation diameter(r= 0.342) 2) The angiographic size have a significant(p<0.01) correlation with the operation diameter (r=0.842) 3) The echo diameter has the best correlation with the operation diameter(r=0.935; p<0.01) The operation diameter can be estimated by the equation: 1.05 x echo diameter in millimeters+0.93mm. It is concluded that operation diameter of ASD can be estimated accurately by two-dimensional subcostal echo measurements, which in turn could be used for selection of device size for occlusion of the ASD.
Angiocardiography ; Echocardiography* ; Gangwon-do ; Humans

Ineffective cerebral perfusion by low cardiac output may cause various types of dizziness like mild lightheadedness, vertigo or presyncope, and sometimes it can be the only heralding symptom. Differential diagnosis with other causes of dizziness is important because the symptom may progress into life-threatening bradyarrythmia and loss of consciousness. There are several literatures that reporting the association between cardiac disease and dizziness and their improvement with treatment of cardiac problem including pacemaker placement. But these are only indirect evidences to explain the cause-symptom relationship. We experienced 48-year old woman who has had recurrent dizziness of rotatory type lasting for about 5 seconds since first year, and then diagnosed atrioventricular block after. She has been having anti-hypertension medications for 2 years. She didn't have any abnormalities in electrocardiography, chest x-ray, or routine blood tests. There were no abnormalities in vestibular function test and electronystgmography. Her result of 24-hour Holter monitoring clearly elucidated temporal relationship between arrhythmia and her episodic symptoms of dizziness. The authors report a case with review of literatures about cardiogenic dizziness.
Arrhythmias, Cardiac ; Atrioventricular Block ; Cardiac Output, Low ; Diagnosis, Differential ; Dizziness ; Electrocardiography ; Electrocardiography, Ambulatory ; Female ; Heart Diseases ; Hematologic Tests ; Humans ; Perfusion ; Syncope ; Thorax ; Unconsciousness ; Vertigo ; Vestibular Function Tests

AIMTo introduce a new device and catheter to be determining cardiac output through cor sinistrum with thermodilution.

METHODSOwn control was introduced in eight dogs. A pulmonary thermodilution catheter was used through the cor dextrum of the dogs; The new-design catheter was used through artery, and there were two situs to fix:its ahead in left atrium and the ahead near to aortic root. Determine cardiac output (CO) under four circumstances: controlled respiration, apnoea, in controlled hypotension, after controlled hypotension.

RESULTSThere was no significant difference among the parameters (CO and cardiac index) of all circumstances. The CO determined by the pulmonary thermodilution catheter and those by the new-design catheter in two situs were positive correlation, and the gamma were 0.986, 0.989; likewise, the cardiac index (CI) was positive correlation, and the gamma were 0.983, 0.985. The CO and CI by the new-design catheter between two situs were positive, and the gamma were 0.992, 0.988.

CONCLUSIONThe parameters by the new-design catheter and those by the pulmonary thermodilution catheter were concordant. In comparison with the pulmonary thermodilution catheter, the new-design catheter had simple device and could be easily operated.

PURPOSE: To manage a critically ill patient effectively, an emergency physician must make an accurate assessment of the patient's hemodynamic status. Although the hemodynamic status can be accurately measured through the use of a pulmonary artery catheter, this device has significant limitations in the emergency department. Instead, the most commonly used method of measuring cardiac output (CO) in the emergency department is transthoracic echocardiography (TTE). However, TTE has been reported to underestimate the CO. Impedance cardiography (ICG) is an established and accurate technique for noninvasive determination of hemodynamic parameters. Thus, this study aimed to assess the agreement between CO measurements made by using TTE and ICG. METHODS: In 20 healthy volunteers, the hemodynamic parameters (stroke volume and CO) obtained by TTE were compared with the parameters derived from simultaneous measurements by ICG. RESULTS: The mean stroke volumes and COs were 63.9+/-11.6 ml and 4.1+/-0.7 L/min, respectively, by TTE, and 77.2+/-10.2 ml and 5.0+/-0.6 L/min by ICG. The correlation coefficients for stroke volume and CO between TTE and ICG were 0.77 and 0.64. The mean difference in stroke volume between TTE and ICG was -13.3+/-6.4 ml (-19.5+/-10.5 %), and the mean difference in CO was -0.88+/-0.48 L/min (-20.1+/-11.6 %). CONCLUSION: In healthy volunteers, the comparison between TTE and ICG showed a good correlation for stroke volume and CO. However, the mean differences in stroke volume and CO between TTE and ICG were -19.5+/-10.5 % and -20.1+/-11.6 %, respectively.
Cardiac Output* ; Cardiography, Impedance ; Catheters ; Critical Illness ; Echocardiography* ; Emergencies ; Emergency Service, Hospital ; Healthy Volunteers ; Hemodynamics ; Humans ; Male* ; Pulmonary Artery ; Stroke Volume ; Volunteers*

The purpose of this study is to investigate changes of the cardiac output and the cardiac muscle contractility during postural gradient changes in man. Subjects consisted of 15 healthy males that they were aged 23-24 years. The Cardiac output and the contractility were calculated using the impedance cardiogram that were recorded by new apparatus developed in Yonsei Medical Center. The impedance cardiogram was recorded in different 7 gradients which were 0degrees, +/-2degrees, +/- 45degrees and +/-90degrees according to the head position, but it was continuously recorded at each gradient. The each postural gradient was changed after supine resting, 15-20 min, and continued in 5 min. Results of this study were following, 1. The cardiac output was decreased at head up posture (+2degrees, +45degrees and +90degrees) because of decreasing stroke volume. But the cardiac output was increased at head down posture (-2degrees, -45degrees and -90degrees) by increasing stroke volume. 2. The cardiac output was significantly changed at +/-45degrees and +/-90degrees after immediately gradient changes, but it was no significant difference at 0 and +/-2degrees postures from that of supine resting state. 3. At +/-45degrees and +/-90degrees, the cardiac muscle contractility was increased, and in head up posture, amounts of change were more larger than in head down posture.
Cardiac Output* ; Cardiography, Impedance ; Electric Impedance ; Head ; Humans ; Male ; Myocardium* ; Posture ; Stroke Volume

PURPOSE: The most common method of monitoring cardiac output (CO) is thermodilution using pulmonary artery catheter (PAC), but this method is associated with complications. Impedance cardiography (ICG) is a non-invasive CO monitoring technique. This study compared the accuracy and efficacy of ICG as a non-invasive cardiac function monitoring technique to those of thermodilution and arterial pressure contour. MATERIALS AND METHODS: Sixteen patients undergoing liver transplantation were included. Cardiac index (CI) was measured by thermodilution using PAC, arterial waveform analysis, and ICG simultaneously in each patient. Statistical analysis was performed using intraclass correlation coefficient (ICC) and Bland-Altman analysis to assess the degree of agreement. RESULTS: The difference by thermodilution and ICG was 1.13 L/min/m², and the limits of agreement were −0.93 and 3.20 L/min/m². The difference by thermodilution and arterial pressure contour was 0.62 L/min/m², and the limits of agreement were −1.43 and 2.67 L/min/m². The difference by arterial pressure contour and ICG was 0.50 L/min/m², and the limits of agreement were −1.32 and 2.32 L/min/m². All three percentage errors exceeded the 30% limit of acceptance. Substantial agreement was observed between CI of thermodilution with PAC and ICG at preanhepatic and anhepatic phases, as well as between CI of thermodilution and arterial waveform analysis at preanhepatic phase. Others showed moderate agreement. CONCLUSION: Although neither method was clinically equivalent to thermodilution, ICG showed more substantial correlation with thermodilution method than with arterial waveform analysis. As a non-invasive cardiac function monitor, ICG would likely require further studies in other settings.
Arterial Pressure ; Cardiac Output ; Cardiography, Impedance ; Catheters ; Electric Impedance ; Humans ; Liver Transplantation ; Methods ; Pulmonary Artery ; Thermodilution